Roller Skating Rink | Pontotoc, MS

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Parent / Guardian Information

Parent's Full Name *

Email Address *

Phone Number *

Please enter a complete 10-digit phone number.

Mailing Address *

City *

State *

ZIP Code *

Student Information

Student First Name *

Student Last Name *

What School Does Student Attend? *

Last Grade Completed *

Student Date of Birth *

Student must be under 18 years old to register.

Student Current Age *

Age calculated from date of birth.

Gender *

If you attend church, may we know where you attend?

Marketing Permission

I agree to receive marketing information from Funtime Skateland via email and/or SMS text messages. I understand that I may unsubscribe from these notices at any time. Your student will receive at least one letter from Funtime Skateland a year delivered to the mailing address provided.

Yes - I agree No - please do not add me

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School Pass Registration

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